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Prediction of microdissection testicular sperm extraction outcomes of azoospermic patients post-chemotherapy using cyclophosphamide equivalent dose

  • Fertility Preservation
  • Published:
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Abstract

Purpose

We determined the sperm retrieval rate in men with persistent azoospermia post-chemotherapy in relation to cyclophosphamide equivalent dose (CED), a unit for quantifying alkylating agent exposure.

Methods

Medical records were retrospectively reviewed of 1098 patients diagnosed with non-obstructive azoospermia who had undergone microdissection testicular sperm extraction (mTESE) between January 2010 and 2021 at our institution. Twenty-three patients with a prior history of chemotherapy were included in the study. Oncological data, chemotherapy regime, and dosage were reviewed. The pretreatment hormone profile, CED, and mTESE outcomes were analyzed.

Results

Testicular spermatozoa were successfully retrieved from 11 patients (47%). The mean patient age was 37.3 years (range, 27–41 years), and mean time interval from chemotherapy to mTESE, 11.8 years (range, 1–45 years). Patients exposed to alkylating agents had significantly lower sperm retrieval rates than those not exposed to alkylating agents (1/9, 11% vs. 10/14, 71%, p = 0.009). No men with CED > 4000 mg/m2 (n = 6) had viable sperm in the testes during mTESE. Moreover, patients diagnosed with testicular non-seminomatous germ cell tumors had a favorable sperm retrieval rate (67%) compared to patients with lymphoma (20%) or leukemia (33%).

Conclusion

Patients with permanent azoospermia post-chemotherapy have a lower testicular sperm retrieval rate when the chemotherapy regimen included alkylating agents. In cases where patients have undergone more intensive gonadotoxic treatments, such as higher CED, the likelihood of successful sperm retrieval is low. It is advisable to counsel such patients using the CED model prior to considering surgical sperm retrieval.

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Data Availability

All relevant data supporting the findings of this study will be made available upon request to qualified researchers for the purpose of replication and further scientific investigation.

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Acknowledgements

The authors express their gratitude to Howard En-Hao Tien and Irene Yea-Lan Chang for their assistance with statistical analysis and to Li-Jung Chang for her generous technical support.

Funding

This work was supported by the Taipei Veterans General Hospital (VGH 109-C-132 and V112B-034).

Author information

Authors and Affiliations

  1. Department of Urology, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Rd, 112, Taipei, Taiwan

    Shi-Jie Tsai, Wei-Jen Chen, Eric Yi-Hsiu Huang, William J. Huang & I-Shen Huang

  2. Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Li-Hua Li

  3. School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan

    Li-Hua Li

  4. Department of Urology, College of Medicine, and Shu-Tien Urological Science Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Wei-Jen Chen, Eric Yi-Hsiu Huang, William J. Huang & I-Shen Huang

  5. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan

    Chen-Yu Huang

  6. Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Robert E. Brannigan

  7. Department of Physiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    William J. Huang & I-Shen Huang

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  1. Shi-Jie Tsai
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  8. I-Shen Huang
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Contributions

Conceptualization: S-J. Tsai, I-S. Huang. Data curation: S-J. Tsai, I-S. Huang, W-J. Chen, William J. Huang. Formal analysis: all authors.

Funding acquisition: I-Shen Huang, William J. Huang. Investigation: I-S. Huang, L–H. Li, William J. Huang. Title page (with ALL authors’ information). Methodology: I-S. Huang. Project administration: I-S. Huang. Resources: William J. Huang. Software: S-J. Tsai, I-S. Huang. Supervision: I-S. Huang. Validation: I-S. Huang. Visualization: I-S. Huang. Writing—original draft: all authors. Writing—review and editing: all authors.

Corresponding author

Correspondence to I-Shen Huang.

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Ethics approval

The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments. Approval was granted by the Medical Ethics Review Committee (IRB protocol number: 2021–11-001CC).

Competing interests

The authors declare no competing interests.

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Tsai, SJ., Li, LH., Chen, WJ. et al. Prediction of microdissection testicular sperm extraction outcomes of azoospermic patients post-chemotherapy using cyclophosphamide equivalent dose. J Assist Reprod Genet 40, 2013–2020 (2023). https://doi.org/10.1007/s10815-023-02870-4

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  • DOI: https://doi.org/10.1007/s10815-023-02870-4

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